Service Request Form

For any questions, please contact ARPwave via phone at (952)431-9708 or via email at [email protected]

Date (mm-dd-yyyy)

Unit Type

Clinic or Therapist Name (If Applicable)

Name *

First

Last

Email *

Phone *

Street Address *

City *

State *

Zip Code *

Country (If outside the USA)

Unit Serial Number *

Credits Remaining (If Applicable)

Detailed Description of The Problem

If this is an issue with an accessory please contact the ARPwave office at (952)431-9708

"Ship To" Address if Different Than Above

Loaner Requested

Loaners available based upon availability. Fees may apply.

Additional Comments

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